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Is There a Moral Difference between Active Euthanasia and Physician-Assisted Suicide?

Michael Manning, MD, Catholic priest, in his 1998 book Euthanasia and Physician-Assisted Suicide: Killing or Caring?, explained in the Introduction:

"Many physicians... believe that there is a difference [between active euthanasia and physician-assisted suicide], and surveys have generally shown that a greater percentage of physicians are willing to cooperate in their patients' suicides than are willing to perform active euthanasia."

Is There a Moral Difference between Active Euthanasia and Physician-Assisted Suicide?

PRO (yes)

CON (no)

John Deigh, PhD, Professor of Philosophy and Law at the University of Texas at Austin, in his 2002 article "Physician-Assisted Suicide and Voluntary Euthanasia: Some Relevant Differences" that appeared in the Journal of Criminal Law and Criminology, argued:

"As a matter of common sense, killing yourself is a lot harder than having someone do it for you. Assuming this bit of common sense is correct, there is reason to suppose that people, on average, are less susceptible to being pressured into killing themselves than they are into letting someone kill them...

A second consequence of the common sense point concerns the acts of suicide and submission to euthanasia that would in fact occur as a result of legalization. One natural way to understand the thought that killing yourself is harder than having someone do it for you is that killing yourself requires firmer resolve. The element of passivity involved in your letting another perform the unpleasant task of putting you out of your misery means that your will is not as active as it would be if you performed the task yourself, and thus weakness or irresolution in the will is less likely to cause failure, less likely to cause an interruption in the lethal action. Conversely, then, a completed act of suicide warrants more confidence in its having issued from a will that was strong or resolute than does a completed act of submission to euthanasia. Accordingly, though any act by which a person deliberately hastens his or her death raises concerns about its voluntariness, there is less reason to worry, other things being equal, about the voluntariness of suicide than about the voluntariness of submitting to euthanasia...

One can, to be sure, imagine physician-assisted suicides that are not significantly different from submitting to euthanasia. Assisted suicides in which the amount of assistance is so great as to reduce the patient's role to that of merely taking the very last steps, nothing more than opening a mouth, say, and intentionally swallowing a capsule placed therein by the physician are, practically speaking, equivalent to submitting voluntarily to active euthanasia. And if such suicides were typical of the suicides that resulted from legalizing the practice, then one could not seriously object to conflating it with voluntary active euthanasia when making utilitarian arguments against their legalization... But neither Kamisar [see Yale Kamisar] nor, as far as one can tell, any of the prominent opponents of legalization he cites offers reasons to think that such suicides would be typical. "

The New York State Task Force on Life and the Law's 1994 report entitled When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context explained in Chapter 4, "Decisions at Life's End: Existing Law":

"Although it is frequently argued that suicide assistance and active euthanasia are morally equivalent, the law in all states draws a clear distinction between these two types of acts. In New York, assisting a suicide, except in certain limited circumstances, is a form of second-degree manslaughter. Euthanasia, however, falls under the definition of second-degree murder, as the defendant intentionally causes the death of the victim through his or her direct acts. Because the consent of the victim is not a defense to murder, euthanasia is therefore prosecutable as murder in the second degree. "

Frances Kamm, PhD, Lucius Littauer Professor of Philosophy and Public Policy at the John F. Kennedy School of Government, Harvard University, in her essay "Physician-Assisted Suicide, Euthanasia, and Intending Death" that appears in the 1998 book Physician-Assisted Suicide: Expanding the Debate, explained:

"Euthanasia involves a death that is intended (not merely foreseen) in order to benefit the person who dies. It differs from physician-assisted suicide undertaken in the interest of the person who dies partly in that it involves a final act or omission by someone other than the patient (e.g., the doctor) in order to end the patient's life.... In active euthanasia, the doctor introduces the cause of the patient's death, e.g., a lethal injection.... Active physician-assisted suicide can involve, for example, the provision of means of death, like pills, that a patient may use. However, it might also involve giving the patient a stimulant to keep him awake so that he can shoot himself. That is, the active assistance need not involve giving a lethal substance."

R.G. Frey, PhD, Professor of Philosophy at Bowling Green State University, in his chapter "Distinctions in Death" that appears in the 1998 book Euthanasia and Physician-Assisted Suicide: For and Against, argued:

"The literature has taken as the dividing line between PAS [physician-assisted suicide] and AVE [active voluntary euthanasia] the matter of who acts last, causally, in producing the patients death...

In each of the cases, the doctor helps to produce or bring about his patient's death as a result of a request by a competent, informed, and autonomous individual for assistance in dying. What seems common to them all is that patient and doctor act together to bring about the death of the patient; in this light, they simply represent different ways patient and doctor may interact to produce this death. What turns, then, upon calling one PAS and calling another AVE?

Suppose a doctor rigs up a machine that enables his patient to breathe carbon monoxide but leaves it to the patient to press the button that turns on the machine: what is the difference between this case and one in which everything is the same except that the doctor pushes the button to start the machine? To say that the latter is a case of AVE while the former is a case of PAS simply becasue of who acts last is not yet to point to a moral difference between them. In both cases... what happens is that the patient and doctor act together to bring about the death of the patient. "

John Keown, PhD, Professor of Christian Ethics at Georgetown University, in his 2002 book Euthanasia, Ethics and Public Policy: An Argument Against Legalization, explained:

"Many remain unconvinced that there is any significant moral difference between the two [voluntary active euthanasia (VAE) and physician-assisted suicide (PAS)] and advance a number of counter-arguments. First, they argue that the supposed greater degree of patient control in cases of PAS is overstated...

Secondly, if one of the main moral arguments advanced by campaigners for PAS is respect for the autonomous request of a suffering patient, why should the patient's autonomous request for VAE not carry equal weight? Why should a patient who wants the doctor to administer a lethal injection (and a doctor who wants to comply) not have their autonomy respected?...

Thirdly, the physical difference between intentionally ending the patient's life, and intentionally helping the patient to end his or her own life, can be negligible. What, for example, is the supposed difference between a doctor handing a lethal pill to a patient; placing the pill on the patient's tongue; and dropping it down the patient's throat? Where does PAS end and VAE begin? It is easy to see why many conclude that the supposed distinction between PAS and VAE, even when it can be drawn in the physical world, has little significance (if any) in the moral world. "

Dan Brock, PhD, Professor of Medical Ethics at Harvard Medical School, in his 1992 article "Voluntary Active Euthanasia" that appeared in The Hastings Center Report argued:

"In the recent bioethics literature some have endorsed physician-assisted suicide but not euthanasia. Are they sufficiently different that the moral arguments for one often do not apply to the other? A paradigm case of physician-assisted suicide is a patient's ending his or her life with a lethal dose of a medication requested of and provided by a physician for that purpose. A paradigm case of voluntary active euthanasia is a physician's administering the lethal dose, often because the patient is unable to do so. The only difference that need exist between the two is the person who actually administers the lethal dose - the physician or the patient. In each, the physician plays an active and necessary causal role.

In physician-assisted suicide the patient acts last (for example, Janet Adkins herself pushed the button after Dr. Kevorkian hooked her up to his suicide machine), whereas in euthanasia the physician acts last by performing the physical equivalent of pushing the button. In both cases, however, the choice rests fully with the patient. In both the patient acts last in the sense of retaining the right to change his or her mind until the point at which the lethal process becomes irreversible. How could there be a substantial moral difference between the two based only on this small difference in the part played by the physician in the causal process resulting in death?"